PH: + 61 2 9226 0299
Individual 1
Individual 2
Individual 3
Full Names of beneficiaries
Residential Address
PO Box is not acceptable in the Residential Address Field
Postal Address
Registration Address
If no registration address is noted, your postal address will be used for your registration address.
If you wish to authorise a third party to operate your account, please complete the below details. Until you notify us in writing that the authority has been revoked, the following person is authorised to act on your behalf, including giving dealing and other instructions, information and requests and/or receive account information.
Quotation of your Australian tax file number(s) (TFN) is optional
Pershing is an Australian financial service licensee that is authorised by law to request your TFN. You are not required to provide your TFN and failing to provide your TFN to Pershing is not an offence. If Pershing is unable to quote your tax file number or exemption to registries, it may be obliged to take tax at the highest marginal rate from any dividends, distributions, interest and payments to which you are entitled. Accordingly, failing to provide your TFN or not permitting Pershing to quote it in relation to an investment may have taxation consequences. You may wish to seek independent advice in this regard.
By providing a TFN and signing the Application Form you:
  • appoint Pershing as your agent and request and authorise Pershing to;
    • provide your Tax File Number to all investment bodies with whom Pershing acts on your behalf;
    • apply your TFN to any investment or account which you may in future make or open with or through Pershing (and their related bodies corporate) to which your TFN may lawfully be applied; and
  • acknowledge that this authority will apply until such time as it is revoked in writing to Pershing.
Despite the other terms in this section, you may instruct Pershing in writing at the time of making an investment, not to quote your TFN In relation to that investment.
Authorisation of the electronic dispatch of confirmations.
The authorisation and agreement in this section apply if you have provided an e-mail address for the despatch of trade confirmations and signed the Application Form. By doing so you authorise confirmations to be dispatched electronically to:
  • you at the e-mail address provided in Section 5
  • another person or organisation (as your agent) to whom you have authorised Pershing to send electronic confirmations, at the e-mail address provided in the Application Form.
Additional Copies of Confirmation Notes:
Pershing cannot send your trade confirmations to a third party; however the third party can be provided with a copy of your trade confirmation. If additional copies are required please provide e-mail or fax details:
Confirmations via Fax
If you wish to receive confirmations via fax, please complete the below details:
Confirmations via Post
In order to complete this section, you should refer to the Explanation of CHESS Sponsorship Agreement and the Pershing Sponsorship Agreement in Part D of this document.
If yes, please confirm
In order to complete this section, the Applicant should refer to Pershing‟s Direct Debit Request & Service Agreement [PART E].
For Direct Debits all bank account holders must sign this section. To link as MMKT a Third Party Authority with the CMA provider must have been completed
Default/Nominated Bank Account The Applicant authorises Pershing to directly credit/debit* the Nominated Bank Account
Please ensure you have read and understood:
In order to process your Application, we will need: